Tatiana Reitblat

Fibromyalgia in women with ankylosing spondylitis

Fibromyalgia (FM), pre-dominantly found in women, may accompany other pre-existing rheumatic diseases. The association between FM and ankylosing spondylitis (AS) is uncertain. We evaluated FM in women with AS. Eighteen women with AS were compared with 18 men with AS (controls) for age, duration of symptoms, time to diagnosis, degree of sacroiliac involvement, history of peripheral arthritis, patient global assessment, Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, level of diffuse pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI). Physical examination included the number of tender points and enthesitis sites, Schober test, distance between occiput and wall, chest expansion, lateral spinal flexion, and intermalleolar distance. Inflammatory activity was measured by the erythrocyte sedimentation rate (ESR). Of all tested parameters, the ones with significant differences between the groups were time between symptom onset and AS diagnosis (longer for women), FM incidence and the number of tender points and enthesitis sites (higher for women), BASDAI (higher in women and correlated with FM and the number of tender points but not with ESR), and BASFI and BASDAI scores (increased in FM patients). FM was present in 50% of women with AS and associated with higher disease activity indices (BASDAI and BASFI) and not related to severity of physical findings or ESR. The reliability of well-accepted assessment tools of AS, such as BASDAI and BASFI, in evaluating AS activity in women may be called into question due to a confounding effect of FM.

Increased 67gallium uptake among polymyalgia rheumatica patients. Is it additional evidence of its vasculitic nature

Giant cell arteritis/temporal arteritis (GCA/TA) and polymyalgia rheumatica (PMR) are closely related conditions that affect middle age and older patients and frequently occur together. Many authorities consider them to be different phases of the same disease. A study was undertaken of the possible contribution of gallium-67 (67Ga) single photon emission tomography (SPECT) scintigraphy to the diagnosis of GCA/TA and PMR, and to support the possible hypothesis of vasculitic nature of PMR. Nine consecutive patients with PMR, and nine consecutive patients with GCA/TA were included in the study. All patients fulfilled the American College of Rheumatology criteria for GCA/TA and Healey’s criteria for PMR. The control patients group consisted of those who underwent 67Ga scintigraphy for febrile illness. All patients and controls underwent 67Ga SPECT scan of the skull on a dual-head Helix gamma camera 2xa0days after I.V. injection of 8–10xa0mCi of 67Ga citrate. 67Ga uptake ratio of temporal bone region to bone out of temporal area (TR/Bone) was estimated on transaxial and coronary slices after SPECT scan reconstruction. For each patient and control the calculations of both temporal areas were done. All GCA/TA and PMR patients showed increased uptake in both temporal areas of the skull, while 67Ga uptake among GCA/TA was the highest, 1.31±0.14 in tranaxial view and 1.47±0.16 in coronary view. 67Ga uptake among PMR patients was lower, 1.19±0.11 and 1.28±0.13, respectively. In comparison, the control patients showed the lowest 67Ga uptake, 1.04±0.09 in transaxial view and 1.11±0.06 in coronary view. The results differ significantly between the three groups. It seems that 67Ga SPECT scan may become a useful tool in the investigation of patients with suspicion of GCA/TA and PMR. Our findings of the increased 67Ga uptake in the temporal areas among PMR patients add new arguments for vasculitic nature of this disorder.

Appearance of ANCA – associated vasculitis under Tumor necrosis factor-alpha inhibitors treatment

Summary Background: Tumor necrosis factor-alpha inhibitors treatment is accosiated with several side effects. The most common are injection side reactions, headache, nausea and infections. The more rare are development of systemic autoimmune diseases. Case Report: We describe two patients, who developed ANCA associated vasculitis during Tumor necrosis factor alpha inhibitors treatment. The diagnosis was confirmed by appropriate tissue picture, CT scan and laboratory findings. Conclusions: Our case series are unique, because vasculitis appeared after many years of the treatment and during complete patient’s remission of there main illness.

Rituximab-Related Late-Onset Neutropenia in Patients with Rheumatic Diseases: Successful Re-Challenge of the Treatment

Case series Patient: Female, 56 • Male, 64 Final Diagnosis: Neutropenia after Rituximab Symptoms: Cough • diarrhea • fever • headache Medication: Rituximab Clinical Procedure: — Specialty: Rheumatology Objective: Unusual or unexpected effect of treatment Background: We describe here 2 patients who developed late-onset neutropenia after Rituximab treatment. While this phenomenon is well described among patients suffering from hematological malignancies, such adverse effects are rare among patients with rheumatic diseases. Case Report: Two patients, the first with rheumatoid arthritis and the second with granulomatosis with polyangiitis, were treated by Rituximab after all previous treatments failed. The patients developed late-onset neutropenia after several courses of treatment. The first patient, with symptomatic neutropenia, recovered after a single dose of granulocyte macrophage stimulating factor, and the second patient’s neutrophils increased spontaneously. Both patients were retreated by rituximab in their scheduled time without further complications. Conclusions: Our case series is unique because the same phenomenon appeared in patients with different rheumatic diseases. This case series confirms the possibility of continuing the treatment without further adverse effects.

Antiphospholipid syndrome and palindromic rheumatism: a new possible association

ObjectiveThe aim of this study was to report six patients with palindromic rheumatism (PR) in whom signs, symptoms, and/or serologic evidence of antiphospholipid syndrome (APS) developed.MethodsThe medical histories of the patients were reviewed with special emphasis on age, gender, duration of PR, and lapse of time until antiphospholipid antibodies were detected or APS was diagnosed. Three representative cases are described.ResultsTwo patients were women and four were men. Their mean age was 49.3xa0years (range 36–80), and the mean duration of PR was 5.5xa0years (range 3–8). In all patients, raised titers of antiphospholipid antibodies were found on two or more occasions. Two patients developed clinical pictures compatible with APS, two showed symptoms which may be attributable for APS, and raised titers of antiphospholipid antibodies were found in only two.ConclusionIt seems that the appearance of these two uncommon conditions together is more than coincidental and may point to a previously unreported clinical association.

The Effect of Prednisone on Tuberculin Skin Test Reaction in Patients with Rheumatoid Arthritis

Objectives To assess the correlation between prednisone and methotrexate (MTX) treatment duration and dosage with the TST induration diameter of the TST reaction among rheumatoid arthritis (RA) patients. Method We retrospectively analyzed consecutive cases of RA patients who were TNF-i therapy candidates. TST measurements, prednisone and methotrexate dosages, and treatment durations were recorded. A control group was randomly selected from healthy subjects. We compared TST reaction size between the following three groups: RA patients with current prednisone treatment, RA prednisone naïve patients, and healthy individuals. Results Our study sample comprised 43 RA patients with prednisone treatment, 22 prednisone naïve patients, and 195 healthy subjects. There was no significant difference in mean TST between the groups (5.3±6.6, 7.8±6.2, and 7.6±7.0, respectively, p=0.149). No correlation was noted between TST size and prednisone u-y (r=0.229, p=0.140) or methotrexate u-y in patients with and without prednisone therapy (r=0.219, p=0.158; and r=−0.293, p=0.186, respectively). Conclusions Our results show that the TST reaction size among RA patients may not be affected by prednisone therapy. In addition, the TST reaction of RA patients may present similarly to that of healthy individuals. Therefore, we suggest that the criterion of a TST reaction of 5 mm to define latent TB infection in our population should be reevaluated.